<FORM action="http://pub48.bravenet.com/elist/add.php" method="post">
<INPUT type="hidden" name="usernum" value="4037641035" />
<INPUT type="hidden" name="cpv" value="1" />
<input type=hidden name="recipient" value="aliakyildirim@myself.com">
<input type=hidden name="subject" value="Email Formu">
<input type=hidden name="return_link_url" value="http://neunkirchen.kolayweb.com">
<input type=hidden name="return_link_title" value="Ana Sayfa(geri dönüş">
<table cellpadding=0 cellspacing=1 border=0 bgcolor=#efefef>
<tr>
<td align=center bgcolor=#ffcc33><font face=arial size=2><b>Email Formu</b></font></td>
</tr>
<tr>
<td align=right><font face=arial size=2><b>İsminiz:</b></font>
</td>
<td><input type=text name="isim" value="" size=30></td>
</tr>
<tr>
<td align=right><font face=arial size=2><b>E-Mail:</b></font>
</td>
<td><input type=text name="email" value="" size=30></td>
</tr>
<tr>
<td align=right><font face=arial size=2><b>Web Siteniz:</b></font>
</td>
<td><input type=text name="url" value="" size=30></td>
</tr>
<tr>
<td align=right><font face=arial size=2><b>ICQ #:</b></font>
</td>
<td><input type=text name="icq" value="" size=30></td>
</tr>
<tr>
<td align=right><font face=arial size=2><b>Şehir:</b></font>
</td>
<td><input type=text name="sehir" value="" size=30></td>
</tr>
<tr>
<td align=right><font face=arial size=2><b>Ülke:</b></font>
</td>
<td><input type=text name="ulke" value="" size=30></td>
</tr>
<tr>
<td align=right valign=top><font face=arial size=2><b>Mesajınız:</b></font></td>
<td><textarea name="mesaj" cols=44 rows=5 wrap="physical"></textarea></td>
</tr>
<tr>
<td> </td>
<td align=center><font face=arial size=2>
<input type=submit value=" Gönder ">
<input type=reset value=" Sil "></font></td>
</tr>
</table>
</form>